MEDICAL LIBRARY AND HISTORICAL Vol. 2 JOURNAL No. I January, 1904 THE "PHTHISIOLOGIA" OF RICHARD MORTON, M.D.* By WILLIAM OSLER, M.D., August 22, 1662-Black Bartholomew's Day, as it has been called-brought sadness and sorrow to many English homes. The enforcement of the Act of Uniformity called for subscription to the Thirty-nine Articles, and enforced the use by all clergymen of the Book of Common Prayer. Among those ejected for refusal to subscribe-2,000 in number, it is said-was a young man, aged twenty-five, the Vicar of Kinver, in Staffordshire, Richard Morton by name. The son of a physician, born in 1637, he had been educated at Oxford, where he took the B.A. in 1656-57, became chaplain to his College and took the M.A. in 1659, and in the same year was appointed to the vicarage of Kinver. From the days of St. Luke there have been many instances of what has been called the angelical conjunction of physic and divinity. In the seventeenth century many men could sign after their names, did Robert Lovell in his History of Animals and Minerals (1661), lobeloɣtaτpóvopos Following Linacre's example, clerical orders have been taken as a rule by the physician late in life, but Morton, ejected from his living, turned his attention to medicine at a comparatively early age. From Baxter's account, he evidently was a loss to the church. He speaks of him as "a man of great gravity, calmness, sound principles, of no faction, an excellent preacher, of an upright life." It is not known where Morton studied medicine. On the nomination of the Prince of Orange he was created an M.D. of Oxford in 1670. He settled in London, became a Candidate of the Royal College of Physicians in 1675, and a Fellow in 1679. He prac *Read before the Johns Hopkins Hospital Historical Club, January, 1900. tised in Grey Friar's Court, Newgate Street, and had an unusual measure of success. He became physician-in-ordinary to the King, and enjoyed the confidence both of the profession and of the public. He seems to have been an intimate friend of Sydenham and a strong supporter of his new way in physic. He died in 1698. His most important work is the Phthisiologia, 1689, of which there were six or seven subsequent editions in the succeeding century. Two English translations appeared, one in 1694, and the other in 1720. His Pyretologia appeared in 1692, and is chiefly of value today as giving one of the most systematic and thorough accounts of the malarial fevers of that date. The Phthisiologia is one of the first systematic treatises on pulmonary consumption. The writers of that date had, however, not got beyond the classification of phthisis given by Celsus and which embraced the forms of disease with which wasting and atrophy were associated, i.e., atrophia, cachexia and phthisis proper, or consumption. Morton's title-page of his English edition gives very well his classification: Phthisiologia: or a Treatise of Consumptions. Wherein the Difference, Nature, Causes, Signs, and Cure of all sorts of Consumptions are explained. Containing Three Books, I. Of Original Consumptions from the whole Habit of the Body; II. Of on Original Consumption of the Lungs. III. Of Symptomatical Consumptions, or such as are the Effects of some other Distempers. Illustrated by particular Cases, and Observations added to every Book. With a Compleat Table of the most Remarkable Things. Of these, Book II alone concerns us at present. Book I deals with the wasting associated with discharges of all sorts, suppurations, diabetes, dropsies, sweats, etc. Two points may be mentioned in passing. Under what he terms nervous consumption, I think we may recognize Gull's anorexia nervosa, particularly in the history of the two cases which he Under the section "De Tabe à Diabete," which he calls "Hydrops ad Matulam" (dropsy of the chamber-pot), he describes, for the first time, I believe, the family form in children and notes one case of recovery in childhood. narrates. Morton was one of the first to give a clear account of tubercles in the lungs. Celsus had used the word tubercle and was stated to have introduced it into the language of medicine, but by it he really meant any small round tumor of whatever nature. Mor ton's description of tubercle is as follows: "A crude Tubercle or Swelling is bred from the Obstruction of some Glandulous part of the Lungs; to wit, when a greater quantity of Serum, or Water is separated from the Blood, than is thrown out by the Duct of the Glandule: From whence is comes to pass, that as the Part affected being too much distended by the Humour that is imprisoned in it, is deprived of its natural Tone, and thereupon is no longer able to spew or throw out the Serum, or Water that flows into it, or is separated; so likewise the Humour, that is so shut up, not being any more renewed by an influx of fresh Humour, does by degrees grow dry and hard from the Natural heat of the Part: From whence arises a hardness, that resists a pressure, or a Tubercle (of which we are now speaking) which in progress of time, after the natural Tone of the Part is in this manned destroyed, is wont to be inflamed, and to turn to an Aposteme sooner or later, according to the Nature of the Lympha, or included Humour, and of the Blood, from which it is separated, which indeed is the whole immediate cause of a Consumption of the Lungs, and of the dry cough which attends it." A very interesting point is that he had a strong belief in the very great prevalence of tuberculosis of the lungs, and he says: "Yea, when I consider with my self, how often in one Year there is cause enough ministered for producing these Swellings, even to those that are wont to observe the strictest Rules of Living, I cannot sufficiently admire that any one, at least after he comes to the Flower of his Youth, can dye without a touch of a Consumption. And without doubt the breeding of these Swellings is so frequent and common, that a Consumption of the Lungs would necessarily be the common Plague of Mankind, if those Swellings did not vanish, or were not removed by Art as easily as they are bred at first: And indeed I have been used to think, not without Reason, that as the more Benign Tubercles are wont to go off of their own accord, and that quickly, so none of them lay the Foundation of this great Disease, of which I am now treating, but only those which are in some degree Malignant, and ill-natur'd, and that are wont to putrefie sooner or later from some peculiar quality in their Nature, from what part soever of the Body they have their Original.” Among the procatartic or predisposing causes he mentions want of exercise, night studies and watchings, a hereditary disposition, an ill-formation of the breast, whether natural or accidental, and infection. The more immediate cause was the taking L L |